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limpy,
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I strongly feel that very?few people with proven gout will find 200 mg. allopurinol enough for long term complete control.
Go onto 300 mg. It will be more effective and will actually COST you less.
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Is Naproxyn good or bad for your heart…that question has a funny answer: it is probably BOTH.
Some NSAIDS block the agglomerating action of platelets, thus less blood clots in heart (MI)?and brain (ischemic stroke.) Problem is that most act short term, blocking for around a day or less. Aspirin on the other hand, blocks platelets for a week. And here's the rub, the other NSAIDS prevent aspirin from doing its job. So if you take aspirin and Naproxyn, you are probably doing yourself a disservice, BAD. If you do NOT take aspirin, you are preventing clots slightly with Naproxyn, GOOD.
Funny business, eh?
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I am caught betwixt and between. I LIKE naproxyn for pain but I NEED aspirin for the certainty of?platelet control. I sometimes take both and hope for the best.
I've stored colchicine at room temperature for 10 years with no apparent diminution in effectiveness. I recommend storing OUTSIDE the bathroom because of humidity concerns.
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I would think that freezer storage would be even better because most chemical reactions slow at lower temperatures. For freezer storage I recommend a TIGHT seal and perhaps even one of those silica gel cylinders to absorb moisture. Store in several bottles so that when you need a couple pills you don't have to defrost the whole shebang.
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(I am hoping for longer life freezer storage for my nitroglycerine pills. The FDA is apparently pulling the same fu#@ing scam with nitroglycerine that they did with colchicine, the price is soaring, like 50-fold,?and unlike colchicine nitroglycerine pills are VERY fragile.)
Dear sdgfrofg.
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First let me congratualte you on having the very WORST screen name I have ever seen.
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Is it gout or not? Impossible to tell.
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What I recommend is watchful waiting. Don't do too much changing of habits else you screw up the diagnosis. Just go on as before watchfully waiting to see if it happens again.
Even if it IS gout, there isn't much reason to treat it after one attack. Heck, that could be the only attack you suffer in 80 years.
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What do I think it is if pressed? You damaged either bone, ligament, or cartilege stamping on that wood?a traumatic injury that is unlikely to recur. But time will tell the tale. Not having another attack is a nice prospect.
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p.s., Never take a drug that you cannot identify?even if GOD gives you the prescription.
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During the day (2:00PM on 06/01/11) I stamped on a wooded pallet
Where did you buy your time machine, I'd LOVE one for the stock market.
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p.p.s., Have your doctor X-ray your foot to check for a hairline fracture.
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Atta boy, Art.
The allopurinol is doing exactly what it is supposed to and you should be looking at a pain free, or at least GOUT pain free life ahead.
Don;t expect too much with the shoulder though. I have mangled rotator cuffs and they hurt periodically no matter what. I just have to spend several/many weeks staying off bench presses.
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When was your last acute?attack?
OH…MY…GOD!
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Is there ANYPLACE urate won't deposit?
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I guess it's logical because the outer surfaces of the eyes must get quite cool in Winter.
Gerry,
Since you have chronic tophaceous gout perhaps you might consider getting your urate level lower. I translate your molar reading to about 5.3 mg./dL.
Levels down to 3.0 are sometimes used to clear tophi. It is acheivable using TWO urate controlling drugs, a xanthine oxidase blocker and a uricosuric.
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Are your doctor's excursions with a pickaxe very painful? Does he anesthetize the toe?
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Keith,
Thanks for the SEARCH tip and for the?kind personal reference.
nokka,
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Rashes are rashes are rashes. If you get them on your groin you assume fungal and treat with one after another of the 100 antifungals that treat jock rash. If you have them on your foot, the same. If you wife has it on her vagina it's judgeed yeast and nystatin is used. On the face the catchall diagnosis is usually sebborheic dermatitis and more trial and error.
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And then there are the thousand other rashes that neither doctor nor patient can identify so a mix of antifungals, antibiotics, anti yeast and cortisone is tried (cortisone stops the inflammation of all rashes, but? does not cure them.)
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All of this is to say it is very?hard to make anything out of a rash.
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The exceptions are sudden hives and facial swelling with?swollen eyelids and lips?this is a sign of allergic angioedema and means STOP THE DRUG, because your life may be in danger.
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But run-of-the mill rashes are illusive creatures.
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If anyone has a webshot of a proven “allopurinol rash,” please post it…I've never seen anything.
I hope no one has this experience with the new “monopoly” gout drug that is supposed to be the same as the tried and true colchicine.
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Bulas,
the new version, Colcrys, is identical to the old orphan drug colchicine. The TROUBLE is being able to aford it in proper quantity and even get your doctor to PRESCRIBE it now that THE COMPANY? has proclaimed from on high that 3 pills?is enough (to stop half your pain.) This would be hilarious but for all the pain it is causing.
Thank you Mr. Obama.
from Island: Alupurinol doen't do anything to me, I think it even makes my attacks worst.
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Allopurinol is NOT for stopping pain once a?but for?preventing attacks from ever beginning. The correct way to take it is to start and then take it daily, forever. It really IS the answer to gout. NEVER consider taking it short term.
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I've been doing some research online and lots and lots of reading, and now I'm going to start using it as a cooking ingredient. Maybe cookies or some kind of sauce, even a pasta dish.
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Would that make you a PASTAFARIAN?
Any diet you are on that includes 300 mg. allopurinol* is a good gout diet. ANY diet that is ABSENT the allopurinol is a bad gout diet.
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* I use “allopurinol” to include any urate lowering drug.
from Gerry: That photo was taken 3 days after it was cleaned of all tophi.
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Your podiatrist missed a bunch becasue I can clearly see exposed “chalk” which is FAR from where your toe joint should be. Is it possible he wants you coming back every fortnight FOREVER?
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What drugs are you taking and how long have you been on it/them?
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(I apologize for my memory and ther's no way that I can see?to call up your old posts in one place.)
OUCH,
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Jerry, If I had that toe at the end of my foot I wouldn't be able to resist taking a dental pick GENTLY to that whitee area on the top inside of the toe. Perhaps I could ignor it for an hour or so but then I would HAVE to dive in.
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How long did it take to get that big?
I agree, and it wouldn't be so bad if the doctors weren't so ARROGANT, making believe they know or care about gout. They spout nonsense rather than admit “I don't know much about gout and care even less so you are on your own.” At least then we could proceed on the correct path without their hindrance. Arrogance is tolerable from a genius who is helping you?but from some doof who barely scraped through medical school in Guadalahara or Calcutta it is an abomination, especially when he is HURTING you and charging you for the offense.
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Toofast is correct, gout is easy to treat and requires little follow up for reasonably effective treatment. Had it not been necessary to get new prescriptions, I wouldn't have had to have a doctor involved for the last 15 years, just? a steady stream of cheap effective allopurinol. With no attacks I could try less allopurinol, if I have an attack I need more. Easy Peasy!?
Thus there is no steady stream of income generated to help buy imperial mansions and a stable of polo ponies for some incompetent quack.
Notice though the TV ads for Uloric?as soon as a huge $$$$pile becomes available, the word gout rises to the surface.
missy,
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Odds are? against gout because of your age, sex, etc. but then the odds are against being run over by a bus on vacation?in Belguim are slight but I know someone who was.
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If you have the screaming bunion the diagnosis is easier but other foot pains not so easy.
Wait on your serum uric acid. Shame he didn't stick a syringe into the toe and suck out some joint fluid. Finding crystals is the most defining test for gout.
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My guess is that you will have to wait through a couple more attacks before beginning long term meds.
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In the good old days, I'd say get a prescription for colchine and see if it has a dramatic effect but Big Pharma in collusion with the FDA has made that route problemmatical for many of us.
toofast,
I think all three drugs are worthy of consideration. How doctors? view them may have come down from? past history with a large dose of heresay.
Both uricosurics are associated with potential for forming urate kidney stones and back a couple decades (before lithotripsy)?these stones often had to be dealt with through surgery. I also remember the two uricosurics as having cross allergy with penicilling and sulfa drugs.
Allopurinol was always considered the SAFEST of drugs. Now however with the internet and the competition from pricey ULORIC, the potential for problems with allopurinol has been amplified, perhaps OVERamplified, how better to sell a pricey competitor.
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For your case, it would seem the logical treatment that for someone who PRODUCES too much uric acid the logical choice seems a drug that causes less production, but the consensus seems to be that alloprinol is the best choice regardless of over or under production.
(The?most effective?of all the drugs is benzbromarone, but it's manufacturer stopped selling it in the U.S. and most other countries after evidence of liver toxicity.)
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I feel that taking everything into consideration that allpurinol should be tried first and if not effective enough or it causes side effects, then probenecid or sulfinpyrazone should be tried, perhaps heeding the warnings about cross allergies to choosee betweeen them.
For tophaceous gout or really high urate levels the combination of allopurinol + uricosuric works really well to give VERY low uric acid levels.
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I've never tried a uricosuric?let me take that back, I DO use daily losartan, albeit a weak uricosuric.
cantaner,
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Once you have determined that allopurinol is causing a rash, you are correct that you cannot take it for fear of a very dangerous reaction. Your choices then become the frightfully expensive Uloric, or one of the two cheap uricosurics?( make you pee out more uric acid.)
Your sensible choices become probenecid or sulfinpyrazone?with a goal just like allopurinol, to keep your serum uric acid below 6.0 (or better, 5.0.)?
Obama's FDA did the same thing with nitroglycerine, another oprphan drug. They gave exclusivity to Pfizer and now the under tongue pills and spray bottles have gone up in price several thousand percent. THey now cost close to the price of Cocrys…
So now the movie plot will go:
Old version:
husband, grasping chest: “Get me my pills!”
wife: “Die you old fool…now I have your money AND Joachim, the gardener!”
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New version:
husband, grasping chest: “Get me my pills!”
wife: “Honey, don't you remember, we couldn't afford them!”
Hi cantaner,
Stopping allopurinol and rolliing uric acid up around 10 will cause you SUCH an attack you'll wish you weeren't born.
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Now, what to do about it:
A doubling of ALT is usually not serious and can be caused by MANY things.
Mild to moderate elevations of the liver enzymes are commonplace. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter.
One of the most common cause of mild to moderate elevations of these liver tests is a condition called fatty liver. In the United States, the most frequent cause of fatty liver is alcohol abuse. Other causes of fatty liver include diabetes mellitus and obesity. Chronic hepatitis C is also becoming an important cause of mild to moderate liver enzyme elevations.
http://www.labtestsonline.org/understanding/analytes/liver_panel/test.html
SERIOUS liver problems usually give ALTS that are 10 times the upper level of 56. The fact that your ALT did not quickly come back to normal is evidence that perhaps the allopurinol was NOT the cause of the elevated level.
If I were you I would go back on the allopurinol and just keep an eye on the ALT. You REALLY don't want a full blown attack. Perhaps you have forgotten how AWFUL the attacks were 2 years ago. In an ideal world we would all have perfect liver function numbers…and neither would we have gout, but our world is not ideal.
Glad to hear it's all working out well for you toofast.
Why not consider upping your allopurinol to 400 mg. to guarantee that you slide down below 6.0 mg.dL.
Not to be too repetitious, but I recommend starting with 400 mg. allopurinol and titrating down from there after a couple months if uric acid is super low.
I think the higher dose of allopurinol will mitigate the likelihood of post allopurinol attacks. I can't PROVE it, but I think it is likely. Nothing to be lost but a few pennies a day.
I agree with you almost completely that a dietary regimen would be NICE, but they are all ineffective. It is a shame that some people must wade though all the claptrap advertised as cures before finding the drug regimen that actually DOES. THe internet is making the situation worse. THe years and years of delays is resulting in much more joint damage than necessary.
Would someone avoid antibiotics if they had a severe infection becasue the internet touts tea tree oil or ginseng? Would they avoid quinine and turn to prayer if they caught malaria? Would a diabetic avoid his insulin and try Vitamin C megadosing?
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I disagree about needing to reach a pain/inflammation?peak before beginning to “cure.” I know from experience that an attack can be aborted with proper drugs an hour after it starts.
Hans said: An increase of uric acid in your system (of course, there is are reasons for that to begin with) which generally trigger the deposition of those nasty critters, called uric acid/mono sodium urate crystals, which cause the inflammation, which causes the the pain.
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Just a little quibble: Inflammation cause a localized acid condition which casues MORE urate to precipitate thus self perpetuating the attack. In addition to mitigating the inflammation, colchicine is thought to alkalyze the joint further stopping the runaway process. There is evidence that colchicine also tempers the body's immune response to the urate. Colchicine does things that no other drug does.
I find my response to colchicine is nothing short of remarkable. A small sample, granted,?but enough to convince me that it is the best drug by a wide margin for a frank gout attack.
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I don't differentiate between inflammation and pain (and even swelling). Whether it is a gout attack, an abcessed tooth, an appendicidis, or a strep throat, inflammation and pain seem to me to be very much the same thing.
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Brett,
You have nice looking feet.
How about this approach:
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If you are in a big city go through the Yellow Pages and call ever GP until you reach one who HAS gout. That way you can be sure of getting someone who?UNDERSTANDS gout.
I asked the doctor last week about increasing Allopurinol but he told me that 300mg was the maximum dose.?
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The man is a fool who apparently knows NOTHING about gout and its management. The maximum dosage is considered to be 800 mg. NOT 300 mg. The reason I asked about your size is that while 300 mg. might be fine for someone at 150 pounds, it might not be enough for someone over 200 pounds. A big guy will EAT more than a small one and break down more tissue as well. Both are sources of purines and more purines need more allopurinol to block their conversion to urate.
It seems only common sense that if I got an attack after 6 months of 300 mg. allopurinol, my body is telling me to try 400 mg. In fact I spent my first year on 400 mg…and NO rebound attacks. I then spent a decade on 300 mg. and at my doctor's urging I went down to 200 mg but started getting the telltale bunion twinges in the morning and a urate of 6.8. I went back to 300 mg. confident I had found my level. (I am 6'2″ and 205#.)
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I would classify indomethacin as the second best analgesic for gout pain despite the fact that it makes me and others dizzy. Last time I took it I almost did a header down an escalator.?
But only colchicine will act to stop an attack. The assholes who get a drug flyer from a prednisone manufacturer and discard two millennia of sensible gout treatment? are truly infuriating. Just DUMB Doras masquerading as medical professionals?and their are enirely too many of them around. THey should recognize their limitations and get jobs delivering mail.
I would dispute ANYONE who thinks that predniisone is a safer drug than colchicine.
Not giving up beer & gout
?In the hope of raising my spirits a little, does anyone know of any early indications that an attack is about to end? That is before the pain goes.
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I know people are different but MY attacks always stopped as abruptly as they started?with no warning.
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Have you thought of colchicine to stop the attack? It works better than either NSAIDS or codeine which just make pain, usually poorly.
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I think the only real competitor to colchicine for pain relief?are steroids like prednisone?or the really hard drugs like opiates. But ONLY colchicine will actually work to STOP an attack.
?This attack is a week and a half old and from past experience, I reckon it will be another week or so before it eases.
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Past experience is a poor barometer for gout attacks. My first 4 or 5 attacks passed in EXACTLY 3 days requiring crutches but no drugs. My last, however, was a 9-day killer that had me bedridden in immense pain. I stopped that attack completely?in a day with a massive dose of colchicine (22 little buggers.)? Next day I was perfectly well except for the feeling that I had had an enema with a firehose.
I immediately started allopurinol and never had another attack, only twinges.
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I too have no use for dietary changes that are of dubious worth. I’d much?rather take a daily pill than give up calves liver, beer, wine, shellfish, steak, fish, etc. etc. and I cannot afford daily cherry juice (can anyone?) 🙂
Do you drink Wine during a Gout Attack? George,
I too have a clindamycin allergy (incredible colitis)?but I have no trouble with taking colchicine. Perhaps your doctor is being over-cautious? Have you found any confirmatoryon-line data indicating this cross sensitivity??It is an important issue because there is no better drug for gout pain than colchicine, although the FDA has made it prohibitively exopensive to take it in effective doses in the United States.
(Does Canada ban all cochicine that is not patent protected as COLCRYS? Canada is not far from upstate New York.)
Getting that December number is important because there is no mandate against taking 400 mg. allopurinol if?urate is not low enough. I started with a year on 400 mg. and never had a frank attack from day one many years ago, so attacks? are not compulsory after starting allopurinol
. Are you a big guy George?burgeszz,
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How much allopurinol are you taking? Have you had your uric acid measured in the last month?
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Colchicine is my favorite analgesic (unless you are stuck in a country that has given?the patent to a rapacious drug company and sold as Colcrys at several thousand percent markup)?and if an attack is caught immediately very little colchicine is needed.
Of course after a week of pain a LOT more colchicine is required.
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Remember, there is nothing wrong with needing MORE than 300 mg. allopurinol…let your uric acid be your guide.
If I had a compromised immune system, what I would do is let it drain but with every daily shower I would smoosh on some cheap OTC triple antibiotic ( typically bacitracin, neosporin and neomyxin?or some such combo) and then wrap it with gauze until the next morning. Probably a cream formulation is less messy than an ointment, but an ointment provides more of a seal.
That way you will get drainage of urate while keeping infective agents out.
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Damn, I HAD one tiny tophus the size of a lentil over the distal joint of my right little finger. I have been drinking beer like a sailor?for?5 months?because of the stress of finding a new home. Anorexia the last month (moving)?caused a 15 pound weight loss which is welcome BUT it also caused the topus to move 1/2 inch in towards me and a second tiny topus is forming over the joint where the original one was. This in a guy who has not had a?frank gout attack in almost 20 years.
I can understand why big old tophi look like a bunch of grapes with each new one adding another “grape” to the pile.
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(When I find and unpack my camera I'll take a picture of the finger.)
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I have gone on the wagon as of January 1 and will not have another drink until April?I do this every year. But I am still musing over the possibility of upping my allopurinol to 400 mg./day.
stormjet,
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Do NOT mention gout when you see your doctor. If he is like most he will immediately assume that your “self diagnosis” is faulty and switch into denial mode.
I have never read that itchiness is at all connected with gout and you are a woman. Both those facts argue against gout. But whatever you do, make sure he does a serum uric acid measurement via bloodtest. Over 6.0 mg/dL points to gout, under that points away. (I'm not sure what units OZ measures uric acid in but get the number and post it here…we'll help.)
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Hip pain may be connected with gout but it is not typical and would be very hard to confirm.
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The best evicence of gout is the swollen big painful big toe joint (the second one in.)
For me it was easy.
After going several years waking up with a sore ankle or instep for no apparent reason but requiring crutches to get around. Every time I thought it was a tendon tear or sprain or plantar fasciitis?done without my realizing it. How often do we register overtreading an ankle?
Each event would be a tedious 3 days with difficult driving and even more difficulty walking then poof all gone with normal analgesics.
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After about 5 of these attacks that were getting more perplexing and more frequent I got the podagra attack in the big toe. It was truly the ATTACK FROM HELL and unmistakeably GOUT. The slightest research told me I needed allopurinol, so off to the doctor I toddled after taking 22 colchicine and stopping the 9 day attack. He yammered some nonsense about my 8+ uric acid being normal and I told him basically “Spare me your nonsense and prescribe alllopurinol.”
I was grateful that I had FINALLY gotten a handle on what had been bedevilling my feet and?upon starting the daily allopurinol?I have been gout pain free for almost 2 decades. Like the man in the bible, I was able to “throw away my crutches and walk!”
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I think that not treating gout properly by controlling uric acid, the road is nearly always downhill and every person with gout will eventually rue their decision to treat only symptoms. Would you treat bacterial pneumonia with cough syrup alone when antibiotics are available?
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But I know it is hard for a person who has never had the AFH to commit to a lifetime of medication, albeit cheap and safe, but once an attack comes that is truly beyond bearable, one will SCREAM for a med that will guarantee it never happens again.
